Shana Alex Lavarreda

The California Health Interview Survey 2001: Translation of a Major Survey for California's Multiethnic Population

The cultural and linguistic diversity of the U.S. population presents challenges to the design and implementation of population-based surveys that serve to inform public policies. Information derived from such surveys may be less than representative if groups with limited or no English language skills are not included. The California Health Interview Survey (CHIS), first administered in 2001, is a population-based health survey of more than 55,000 California households. This article describes the process that the designers of CHIS 2001 underwent in culturally adapting the survey and translating it into an unprecedented number of languages: Spanish, Chinese, Vietnamese, Korean, and Khmer. The multiethnic and multilingual CHIS 2001 illustrates the importance of cultural and linguistic adaptation in raising the quality of population-based surveys, especially when the populations they intend to represent are as diverse as Californias.

The Effects of Varying Periods of Uninsurance on Children's Access to Health Care

OBJECTIVE. Many studies have documented the adverse consequences of uninsurance for children, but less is known about the differential effects of varying periods of uninsurance. This study examines the relative effects of varying periods of uninsurance (uninsured for 1–4 months, 5–11 months, or all year) on childrens access to care. METHODS. Using data from the 2005 California Health Interview Survey Childrens File (ages 0–11), we estimated logistic regressions to examine the effect of insurance status on 6 measures of health care access, controlling for child demographics, child health status, family characteristics, and urban residence. Indicators for insurance status included the following categories: (1) privately insured all year (reference); (2) Medicaid all year; (3) State Childrens Health Insurance Program all year; (4) uninsured for 1 to 4 months; (5) uninsured for 5 to 11 months; (6) uninsured all year; and (7) other insurance all year. RESULTS. We found that children who experience short spells of uninsurance (1–4 months) are less likely to have a usual source of care and are more likely to experience delays in needed care than those with continuous private or public insurance. The consequences are even worse for children who experience more substantial periods of uninsurance, because they are also less likely to receive preventive care (well-child visits and flu shots) or visit the doctor during the year and are more likely to experience delays in receiving needed medical care and prescriptions than those with continuous coverage. The Medicaid program and State Childrens Health Insurance Program in California both seem to have ensured levels of health care access similar to that obtained by children with year-round private coverage. CONCLUSIONS. These findings highlight the benefits gained through continuous health insurance, whether public or private. Public policies should be adopted to ensure continuity of coverage and retention in public insurance programs.

The Impact of Private and Public Health Insurance on Medication Use for Adults with Chronic Diseases

This article examines the impact of public and private health insurance on the use of medications for California adults with any of four chronic diseases: heart disease, high blood pressure, diabetes, and asthma. The data set used is the 2001 California Health Interview Survey. Multivariate analyses were conducted on individuals who had been diagnosed with each of these diseases. Controlling for various demographic, health status, and employment characteristics, the authors find that the uninsured are far less likely to be taking medications for each of the conditions than those with private insurance. Interestingly, those with Medicaid coverage are even more likely than those with private insurance to be taking such medications. The results of this study underscore the importance of health insurance for all persons with chronic conditions and the benefits of Medicaid in particular for low-income adults with chronic conditions.

Switching Health Insurance and Its Effects on Access to Physician Services

Background:This study examines the factors associated with discontinuous health insurance coverage without periods of uninsurance during the past year (ie, switching coverage), and whether it has a detrimental effect on basic access to care. Research Design:We analyze the 2003 California Health Interview Survey samples of adults, ages 19–64 (n = 32,850) and children, ages 0–18 (n = 13,062), using weighted bivariate and multivariate analyses. We stratified the population first by age (modeling adults separately from children) and then by health status (modeling the full population and the population reporting fair or poor health separately). Results:Income, race/ethnicity, age, gender, and rural status were significant factors associated with switching coverage. Adults who switched insurance had significantly reduced odds of having a usual source of care [odds ratio (OR) = 0.63, P < 0.001)] compared with those with continuous coverage. In addition, adults and children who switched coverage were significantly more likely to report delaying care because of cost or insurance issues (adults: OR = 1.65, P < 0.001; children: OR = 2.00, P < 0.001). Children in fair or poor health who switched insurance coverage had much higher odds of reporting a delay in care (OR = 5.48, P < 0.001). Conclusions:Children and adults had disruptions in their basic access to health care when they experienced discontinuous insurance. These findings highlight the advantages of retention of enrollees as one means of promoting access to health care, in the short term, and the benefit of a continuous national health insurance program in the long term.

Underinsurance in the United States: An Interaction of Costs to Consumers, Benefit Design, and Access to Care

Underinsurance is most commonly defined as the state in which people with medical coverage are still exposed to financial risk. We argue that the adequacy of health insurance coverage should also be assessed in terms of the adequacy of specific benefits coverage and access to care. Underinsurance can be understood conceptually as comprising three separate domains: (a) the economic features of health insurance, (b) the benefits covered, and (c) access to health services. The literature provides ample evidence that people who are underinsured have high financial risk and face barriers in access to care similar to those who are completely uninsured. In response to the growing recognition of the problems associated with underinsurance, the Patient Protection and Affordable Care Act of 2010 includes numerous provisions designed to limit costs to consumers, to assure a minimum set of benefits, and to enhance access to care, especially primary care.

Access to Job-Based Insurance for California's Workers and their Families: The Effect of the Great Recession and Double-Digit Unemployment in California

THE CALIFORNIA Journal of Politics & Policy Volume 3, Issue 4 Access to Job-Based Insurance for California Workers and Families: The Effect of the Great Recession and Doublle-Digit Unemployment in California Shana Alex Lavarreda, Ninez A. Ponce, Livier Cabezas, and E. Richard Brown University of California, Los Angeles Abstract Lack of health insurance affects workers and families who depend on job-based coverage for health care. In 2007, the unemployment rate in California was 5.5%. By the end of 2009, it had more than doubled to 12.3%. This study uses data from the 2007 and 2009 California Health Interview Survey to assess changes in ac- cess to job-based health insurance among California workers and their dependents. We find that although increased unemployment dramatically reduced the number of employees, the proportion of employees with no access to job-based coverage through either their own or a spouse’s work remained constant. Among adults with no family access to job-based insurance, the most significant determinants of being uninsured were income and citizenship. Due to more generous public health insur- ance options, children with the lowest household incomes were not significantly more likely to be uninsured than children with higher household incomes. The re- sults highlight the importance of public health insurance for children and confirm the need for the Affordable Care Act’s insurance expansion provisions. Keywords: employment-based insurance, workers, children, recession Copyright